In higher education, standardized academic language proficiency test scores are often used for multiple purposes, including admissions of international students to degree programs and identification of students' post-entry language support needs. In this chapter, issues surrounding the use of high-stakes standardized academic language proficiency tests for making decisions about international English as-a-second-language (ESL) students are explored. Specifically, a) stakeholders' views and knowledge about standardized academic language proficiency tests, b) predictive validity of standardized academic language proficiency tests for academic success, c) the use of standardized language test scores for placement into language support courses, and d) the use of locally developed tests for placement into language support courses rather than standardized tests are discussed. Based on the discussion, suggestions for the appropriate use of standardized language test scores for making admissions and placement decisions are provided.